Tim Worstall

The NHS and MRSA

There’s one obvious question that comes to mind here:

The government’s strategy for halving the number of hospital superbug
infections was in disarray yesterday after a leaked internal memo to
Patricia Hewitt, the health secretary, revealed doubt as to whether the
target could ever be met.

Liz Woodeson, the director of health
protection, warned Ms Hewitt that the three-year target to halve MRSA
infections by April 2008 was likely to be missed. "Although the numbers
are coming down, we are not on course to meet that target and there is
some doubt over whether it is in fact achievable," she wrote in October.

Is there another health system, somewhere else in the industrialised nations, that has an MRSA infection rate half that of the NHS? I have no idea whether there is, but if there is, what is it that they do differently? Why don’t we then copy what they do?

Or is that just too simple?

In

7 responses

  1. dsquared Avatar
    dsquared

    The problem is that MRSA is ubiquitous in the UK; about one in three British people has a colony of it on their skin (it’s not a very harmful bug unless it gets inside your skin, and even then only if you’re not in a state of being strong enough to fight it off). It’s therefore basically ineradicable, and the pledge was a stupid one that should never have been made (and which, indeed, quite possibly owes itself to some civil servant or politician believing that MRSA was carried in “dirty hospitals” rather than on the skin of people.
    FWIW, according to Wikipedia, the only country to have got on top of MRSA was the Netherlands, and the model there appears to be “take the problem really much more seriously, twenty years ago”. In order to halve MRSA incidence, you’d need to institute a massive “search and destroy” policy of testing all patients and regularly screening staff, then immediately isolating cases until they were proven to be free of it. Since that’s not remotely consistent with any realistic capacity constraint, we’re stuck with it (and so are the Yanks). Which doesn’t mean that this program’s been a failure though; it’s so ubiquitous and so expensive that even a 5% reduction in MRSA cases is actually quite a big win.

    Reply
  2. Not Saussure Avatar
    Not Saussure

    Further to dsquared’s comments, in The Netherlands,the BBC reported a couple of years ago, if they find it on a ward, they immediately check all staff who’ve come into contact with a patient and, if they test positive for the disease — which normally lives harmlessly and asymptomatically in the back of the throats of a considerable minority of the population at any one time — they send them home until it’s cleared up.
    That can take several months; even in The Netherlands they apparently not infrequently have to close wards because a considerable minority of their nursing and medical staff are off sick, on full pay, for months at a time, so implementing such a solution here might be problematic, at least for the first year or so.

    Reply
  3. Kit Avatar
    Kit

    In the States they are phasing out wards.

    Reply
  4. lost_nurse Avatar
    lost_nurse

    It’s a political football of the worse kind – and ill-served by the tabloid nature of debate in this country.

    Reply
  5. Julian Rollins Avatar
    Julian Rollins

    I’ve been watching Sir Gerry Robinson’s BBC reality TV investigation of life at one NHS hospital over the last few nights. Fascinating watch, but so frustrating. The system seems to be unable to accomodate any sort of change. Is the NHS fit to take on the MRSA challenge? Not if this documentary is anything to go by. By the end of it I felt that what the system needs is a good injection of Worstall-style economic sticks and carrots…

    Reply
  6. sortapundit Avatar
    sortapundit

    By the end of it I felt that what the system needs is a good injection of Worstall-style economic sticks and carrots…
    Here’s some second grade Taylor-style stuff. Last year an old boss of mine hired me to head up a sales campaign for a hand hygiene device (the igene, here) that simply reminded ward bathroom users to wash their hands after using the toilet (based on the logic that bathroom surfaces may be teeming with bacteria of all sorts, and that people tend to forget to wash unless prompted). Studies have shown that improvements in hand hygiene techniques could reduce infection rates by up to 50% (Pittet (2000) & Larson (2004)), and that audio cues are much more effective than signage at improving hand hygiene compliance rates.
    Over the course of a few months I visited a number of NHS Trusts in my neck of the woods to encourage them to install the device on a trial basis in some of their wards. If they didn’t see a reduction in infections in those wards within 6 months we’d take it no further. If they did they’d think about stocking every bathroom in the hospital.
    Of the ten Trusts I visited only one made a purchase. The other nine expressed interest, borrowed samples, seemed excited about the prospect and then, one by one, cried off with ‘no budget’ excuses.
    Now here’s the economics (from memory, from a job I left many moons ago).
    Putting aside the human cost of unnecessary illness, healthcare associated infections cost the NHS around £1billion each year. Each infection costs £3,700 – that includes direct treatment costs, lost earnings, ongoing care, etc. etc. Most of the cost is borne by the NHS, while the rest is spread out through the wider economy. That figure comes from the NPSA, whose website and statistics can be found here.
    Now, each igene costs £50. Even a large hospital could afford to install a device in every single bathroom for less than the cost of a single infection. As soon as one infection is prevented they’re turning a profit. And yet…
    So, if you decide to stay a while in one of our fine hospitals in the north west, you may want to try one within the boundaries on the Bolton NHS PCT. Everywhere else around here people are pissing on their hands and thrusting them into open wounds. Or something.

    Reply
  7. HJHJ Avatar
    HJHJ

    I’ll tell you what they do.
    They make hospitals compete for customers if they want to survive. How many patients would be inclined to choose a hospital with high rates of MSRA if they had a choice? How many NHS hospitals can go out of business and staff lose their jobs because their users decide to go elsewhere?
    It’s all about incentives.

    Reply

Leave a Reply

Discover more from Tim Worstall

Subscribe now to keep reading and get access to the full archive.

Continue reading